The living will: Does an advance refusal of treatment made with capacity always survive any supervening incapacity?

Medical Law International

Volumn 4, Issue 1, 1999, Pages 1-21

  Bernat, Erwin ^a  

^a UNIVERSITY OF GRAZ   (Austria)

Author keywords

[No Author keywords available]

Indexed keywords

COMPETENCE; HUMAN; LAW; LIVING WILL; MEDICAL ETHICS; PATIENT; PHYSICIAN; REVIEW;

EID: 0032744850     PISSN: 09685332     EISSN: None     Source Type: Journal    
DOI: 10.1177/096853329900400101     Document Type: Review

References (116)

1. Mark Twain, Letters from the Earth, in: Mark Twain, Collected Tales, Sketches, Speeches, and Essays 1891-1910, New York 1992, p. 880, 918.
2. P. Koller, Theorie des Rechts. Eine Einführung, 2nd ed., Wien - Köln - Weimar 1997, p. 80.
3. Ph. Ariès, Geschichte des Todes, 8th ed., Munich 1997, pp. 715 ff.
4. See the American cases Gray v. Romero, 697 F.Supp. 580 (D.R.I. 1988) (persistent vegetative state); Rasmussen v. Fleming, 741 P.2d 674 (Ariz. 1987) (persistent vegetative state) as well as Severns v. Wilmington Medical Ctr., Inc., 421 A.2d 1334 (Del. 1980) (coma).
5. Superintendent of Belchertown State School et al. v. Joseph Saikewicz, 370 N.E.2d 417 (Mass. 1977): When the patient developed leukemia, he was 67, but his I.Q. was only 10 and therefore his mental state corresponded to that of a child under the age of three.
6. Cf. LG (regional court) Karlsruhe, NJW 1992, 756.
7. G.J. Annas, Reconciling Quinlan and Saikewicz: Decision Making for the Terminally Ill Incompetent, Am. J. Law & Medicine 4 (1979) 367, 368; H. Nys, Emerging Legislation in Europe on the Legal Status of Advance Directives and Medical Decision-Making with Respect to an Incompetent Patient ('Living-Wills'), Europ. J. Health Law 4 (1997) 179, 180 f.
8. G.J. Annas, Reconciling Quinlan and Saikewicz: Decision Making for the Terminally Ill Incompetent, Am. J. Law & Medicine 4 (1979) 367, 368; H. Nys, Emerging Legislation in Europe on the Legal Status of Advance Directives and Medical Decision-Making with Respect to an Incompetent Patient ('Living-Wills'), Europ. J. Health Law 4 (1997) 179, 180 f.
9. For Austrian law, see D. Kienapfel, Grundriβ des österreichischen Strafrechts. Besonderer Teil. Vol. I, 4th ed., Vienna 1997, p. 5; R. Moos, Wiener Kommentar (Vienna Commentary on the Penal Code), margin number 27 pertaining to the preliminary statement to §§ 75 ff.; for American law, see A.S. Relman, A Response to Allen Buchanan's Views on Decision Making For Terminally Ill Incompetents, Am. J. Law & Medicine 5 (1979) 119, 121.
10. For Austrian law, see D. Kienapfel, Grundriβ des österreichischen Strafrechts. Besonderer Teil. Vol. I, 4th ed., Vienna 1997, p. 5; R. Moos, Wiener Kommentar (Vienna Commentary on the Penal Code), margin number 27 pertaining to the preliminary statement to §§ 75 ff.; for American law, see A.S. Relman, A Response to Allen Buchanan's Views on Decision Making For Terminally Ill Incompetents, Am. J. Law & Medicine 5 (1979) 119, 121.
11. For Austrian law, see D. Kienapfel, Grundriβ des österreichischen Strafrechts. Besonderer Teil. Vol. I, 4th ed., Vienna 1997, p. 5; R. Moos, Wiener Kommentar (Vienna Commentary on the Penal Code), margin number 27 pertaining to the preliminary statement to §§ 75 ff.; for American law, see A.S. Relman, A Response to Allen Buchanan's Views on Decision Making For Terminally Ill Incompetents, Am. J. Law & Medicine 5 (1979) 119, 121.
12. T.L. Beauchamp/J.F. Childress, Principles of Biomedical Ethics, 4th ed., New York - Oxford 1994, pp. 120 ff. (autonomy); pp. 189 ff. (non-maleficence); pp. 259 ff. (beneficence); B. Schöne-Seifert, Medizinethik, in: J. Nida-Rümelin (ed.), Angewandte Ethik, Stuttgart 1996, pp. 552, 567 ff.
13. T.L. Beauchamp/J.F. Childress, Principles of Biomedical Ethics, 4th ed., New York - Oxford 1994, pp. 120 ff. (autonomy); pp. 189 ff. (non-maleficence); pp. 259 ff. (beneficence); B. Schöne-Seifert, Medizinethik, in: J. Nida-Rümelin (ed.), Angewandte Ethik, Stuttgart 1996, pp. 552, 567 ff.
14. T.L. Beauchamp/J.F. Childress, Principles of Biomedical Ethics, 4th ed., New York - Oxford 1994, pp. 120 ff. (autonomy); pp. 189 ff. (non-maleficence); pp. 259 ff. (beneficence); B. Schöne-Seifert, Medizinethik, in: J. Nida-Rümelin (ed.), Angewandte Ethik, Stuttgart 1996, pp. 552, 567 ff.
15. T.L. Beauchamp/J.F. Childress, Principles of Biomedical Ethics, 4th ed., New York - Oxford 1994, pp. 120 ff. (autonomy); pp. 189 ff. (non-maleficence); pp. 259 ff. (beneficence); B. Schöne-Seifert, Medizinethik, in: J. Nida-Rümelin (ed.), Angewandte Ethik, Stuttgart 1996, pp. 552, 567 ff.
16. In favor, e.g., J. Baumann et al., Alternativentwurf eines Gesetzes über Sterbehilfe, Stuttgart - New York 1986, p. 15.
17. Cf. The Multi-Society Task Force on PVS, Medical Aspects of the Persistent Vegetative State, N. Engl. J. Med. 330 (1994) 1499 ff., 1572 ff.; Medical Ethics Committee of the BMA, Discussion Paper on Treatment of Patients in Persistent Vegetative State, September 1992 (unpublished manuscript).
18. Cf. The Multi-Society Task Force on PVS, Medical Aspects of the Persistent Vegetative State, N. Engl. J. Med. 330 (1994) 1499 ff., 1572 ff.; Medical Ethics Committee of the BMA, Discussion Paper on Treatment of Patients in Persistent Vegetative State, September 1992 (unpublished manuscript).
19. A.E. Buchanan, Medical Paternalism or Legal Imperialism: Not the Only Alternatives for Handling Saikewicz-type Cases, Am. J. Law & Medicine 5 (1979) 97, 102, 115.
20. E. Bernat, Behandlungsabbruch und (mutmaßlicher) Patientenwille, RdM 1995, 51, 53 f; for German law, see, e.g., H.J. Hirsch, Behandlungsabbruch und Sterbehilfe, in: K. Lackner Festschrift, Berlin - New York 1987, pp. 597, 600 f.
21. for German law, see, e.g., H.J. Hirsch, Behandlungsabbruch und Sterbehilfe, in: K. Lackner Festschrift, Berlin - New York 1987, pp. 597, 600 f.
22. F. Merli, Die allgemeine Handlungsfreiheit, JBl. 1994, 233 ff., 309 ff., 318.
23. See E. Deutsch, Das Persönlichkeitsrecht des Patienten, AcP 192 (1992) 161, 171 f.
24. For German law, cf. E. Deutsch, Schutzbereich und Tatbestand des unerlaubten Heileingriffs im Zivilrecht, NJW 1965, 1985 ff. as well as A. Eser, in: A. Schönke/H. Schröder, Penal Code - A Commentary, 25th ed., margin numbers 27 ff. pertaining to § 223.
25. For German law, cf. E. Deutsch, Schutzbereich und Tatbestand des unerlaubten Heileingriffs im Zivilrecht, NJW 1965, 1985 ff. as well as A. Eser, in: A. Schönke/H. Schröder, Penal Code - A Commentary, 25th ed., margin numbers 27 ff. pertaining to § 223.
26. Superintendent of Belchertown State School et al. v. Joseph Saikewicz, 370 N.E.2d 417, 428 (Mass. 1977)
27. Bouvia v. Superior Court, 179 Cal.App.3d 1127 (1986).
28. McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990).
29. For more details, see E. Bernat, Die rechtlichen Grenzen der Sterbehilfe: gezeigt am Beispiel der amyotrophen Lateralsklerose, Wien. med. Wschr. 146 (1996) 195 ff.
30. See BGH, BGHSt. 32, 367; but cf. A. Eser, Sterbewille und ärztliche Verantwortung, MedR 1985, 6 ff. as well as R. Schmitt, Der Arzt und sein lebensmüder Patient, JZ 1984, 866 ff. and H.J. Hirsch, in: K. Lackner Festschrift (1987) 597, 615 f.
31. See BGH, BGHSt. 32, 367; but cf. A. Eser, Sterbewille und ärztliche Verantwortung, MedR 1985, 6 ff. as well as R. Schmitt, Der Arzt und sein lebensmüder Patient, JZ 1984, 866 ff. and H.J. Hirsch, in: K. Lackner Festschrift (1987) 597, 615 f.
32. See BGH, BGHSt. 32, 367; but cf. A. Eser, Sterbewille und ärztliche Verantwortung, MedR 1985, 6 ff. as well as R. Schmitt, Der Arzt und sein lebensmüder Patient, JZ 1984, 866 ff. and H.J. Hirsch, in: K. Lackner Festschrift (1987) 597, 615 f.
33. See BGH, BGHSt. 32, 367; but cf. A. Eser, Sterbewille und ärztliche Verantwortung, MedR 1985, 6 ff. as well as R. Schmitt, Der Arzt und sein lebensmüder Patient, JZ 1984, 866 ff. and H.J. Hirsch, in: K. Lackner Festschrift (1987) 597, 615 f.
34. E. Bernat, RdM 1995, 51, 54 (Fn. 36); but cf. BGH, BGHSt. 32, 367, 370, which implicitly is of the opinion that the crime of "murder on request" can also be committed by omission; criticism expressed by A. Eser, in: A. Schönke/H. Schröder, Penal Code - A Commentary, 25th ed., margin number 10 pertaining to § 216.
35. E. Bernat, RdM 1995, 51, 54 (Fn. 36); but cf. BGH, BGHSt. 32, 367, 370, which implicitly is of the opinion that the crime of "murder on request" can also be committed by omission; criticism expressed by A. Eser, in: A. Schönke/H. Schröder, Penal Code - A Commentary, 25th ed., margin number 10 pertaining to § 216.
36. E. Bernat, RdM 1995, 51, 54 (Fn. 36); but cf. BGH, BGHSt. 32, 367, 370, which implicitly is of the opinion that the crime of "murder on request" can also be committed by omission; criticism expressed by A. Eser, in: A. Schönke/H. Schröder, Penal Code - A Commentary, 25th ed., margin number 10 pertaining to § 216.
37. See, inter alia, the commentary to the government bill of the German Penal Code, BT-Drucks. 6/3434, 29 as well as for Austrian law M. Schwimann, in: M. Schwimann (ed.), Praxiskommentar zum ABGB (The Austrian General Civil Code - A Commentary for Practical Application), 2nd ed., margin number 23 pertaining to § 151.
38. For more details, see B.-R. Kern, Fremdbestimmung bei der Einwilligung in ärztliche Eingriffe, NJW 1994, 753 ff. as well as A. Eser/H.-G. Koch, Rechtsfragen bei der gynäkologischen Betreuung minderjähriger Patientinnen, in: A. Huber/H.-D. Hiersche (ed.), Praxis der Gynäkologie im Kindes-und Jugendalter, Stuttgart - New York 1987, pp. 18 ff.; for Austrian law, see the special provision of § 8 (3) KAG.
39. For more details, see B.-R. Kern, Fremdbestimmung bei der Einwilligung in ärztliche Eingriffe, NJW 1994, 753 ff. as well as A. Eser/H.-G. Koch, Rechtsfragen bei der gynäkologischen Betreuung minderjähriger Patientinnen, in: A. Huber/H.-D. Hiersche (ed.), Praxis der Gynäkologie im Kindes-und Jugendalter, Stuttgart - New York 1987, pp. 18 ff.; for Austrian law, see the special provision of § 8 (3) KAG.
40. Austrian Supreme Court, EvBl. 1988/85; Lane v. Candura, 376 N.E.2d 1232 (Mass. 1978).
41. High Court of Justice (Family Division) [1994] 1 F.L.R. 31.
42. [1994] 1 F.L.R. 32.
43. [1994] 1 F.L.R. 35.
44. Cf. A. Grubb, Med. L. Rev. 2 (1994) 93 ff.
45. K. Amelung, Germany, in: H.-G. Koch/St. Reiter-Theil/H. Helmchen (eds.), Informed Consent in Psychiatry. European Perspectives of Ethics, Law and Clinical Practice, Baden-Baden 1996, pp. 97, 109 f. with further references.
46. Federal law of 1 March 1990, Official Gazette No. 155 (1990).
47. For more details, see Ch. Kopetzki, Unterbringungsrecht II, Wien - New York 1995, pp. 814 ff.
48. Cf. E. Deutsch, Sterbehilfe und Euthanasie als rechtliches Problem, ArztR 1981, 125 ff.; M. Harder, Voluntas aegroti suprema lex - Bemerkungen zum sogenannten "Patiententestament", ArztR 1991, 11 ff.; J. Röver, Einfluβmöglichkeiten des Patienten im Vorfeld einer medizinischen Behandlung, Frankfurt/Main 1997; B. Eisenbart, Patienten-Testament und Stellvertreter in Gesundheitsangelegenheiten, Baden-Baden 1998; B. Kneihs, Grundrechte und Sterbehilfe, Wien 1998, pp. 451 ff.
49. Cf. E. Deutsch, Sterbehilfe und Euthanasie als rechtliches Problem, ArztR 1981, 125 ff.; M. Harder, Voluntas aegroti suprema lex - Bemerkungen zum sogenannten "Patiententestament", ArztR 1991, 11 ff.; J. Röver, Einfluβmöglichkeiten des Patienten im Vorfeld einer medizinischen Behandlung, Frankfurt/Main 1997; B. Eisenbart, Patienten-Testament und Stellvertreter in Gesundheitsangelegenheiten, Baden-Baden 1998; B. Kneihs, Grundrechte und Sterbehilfe, Wien 1998, pp. 451 ff.
50. Cf. E. Deutsch, Sterbehilfe und Euthanasie als rechtliches Problem, ArztR 1981, 125 ff.; M. Harder, Voluntas aegroti suprema lex - Bemerkungen zum sogenannten "Patiententestament", ArztR 1991, 11 ff.; J. Röver, Einfluβmöglichkeiten des Patienten im Vorfeld einer medizinischen Behandlung, Frankfurt/Main 1997; B. Eisenbart, Patienten-Testament und Stellvertreter in Gesundheitsangelegenheiten, Baden-Baden 1998; B. Kneihs, Grundrechte und Sterbehilfe, Wien 1998, pp. 451 ff.
51. Cf. E. Deutsch, Sterbehilfe und Euthanasie als rechtliches Problem, ArztR 1981, 125 ff.; M. Harder, Voluntas aegroti suprema lex - Bemerkungen zum sogenannten "Patiententestament", ArztR 1991, 11 ff.; J. Röver, Einfluβmöglichkeiten des Patienten im Vorfeld einer medizinischen Behandlung, Frankfurt/Main 1997; B. Eisenbart, Patienten-Testament und Stellvertreter in Gesundheitsangelegenheiten, Baden-Baden 1998; B. Kneihs, Grundrechte und Sterbehilfe, Wien 1998, pp. 451 ff.
52. Cf. E. Deutsch, Sterbehilfe und Euthanasie als rechtliches Problem, ArztR 1981, 125 ff.; M. Harder, Voluntas aegroti suprema lex - Bemerkungen zum sogenannten "Patiententestament", ArztR 1991, 11 ff.; J. Röver, Einfluβmöglichkeiten des Patienten im Vorfeld einer medizinischen Behandlung, Frankfurt/Main 1997; B. Eisenbart, Patienten-Testament und Stellvertreter in Gesundheitsangelegenheiten, Baden-Baden 1998; B. Kneihs, Grundrechte und Sterbehilfe, Wien 1998, pp. 451 ff.
53. J. Lachmann, Zur Bindungswirkung des Patiententestaments, öAnwBl. 1991, 74 ff.; M. Memmer, Patientenverfügungen im österreichischen Recht, Wien. med. Wschr. 147 (1997) 135 ff.; G. Kalchschmid, Das sogenannte Patiententestament, Informationen der Patientenvertretung 1/1997, 1 ff.
54. J. Lachmann, Zur Bindungswirkung des Patiententestaments, öAnwBl. 1991, 74 ff.; M. Memmer, Patientenverfügungen im österreichischen Recht, Wien. med. Wschr. 147 (1997) 135 ff.; G. Kalchschmid, Das sogenannte Patiententestament, Informationen der Patientenvertretung 1/1997, 1 ff.
55. J. Lachmann, Zur Bindungswirkung des Patiententestaments, öAnwBl. 1991, 74 ff.; M. Memmer, Patientenverfügungen im österreichischen Recht, Wien. med. Wschr. 147 (1997) 135 ff.; G. Kalchschmid, Das sogenannte Patiententestament, Informationen der Patientenvertretung 1/1997, 1 ff.
56. H.-G. Koch/E. Bernat/A. Meisel, Self-Determination, Privacy, and the Right to Die. A Comparative Law Analysis (Germany, United States of America, Japan), Europ. J. Health Law 4 (1997) 127 ff.; H.-M. Sass et al., Advance Health Care Documents in Multicultural Perspectives, Annual Review of Law and Ethics 4 (1996) 465 ff.; P. Rescigno, Self-Determination and Living Wills, in: C.M. Mazzoni (ed.), A Legal Framework for Bioethics, The Hague - London - Boston 1998, pp. 235 ff.
57. H.-G. Koch/E. Bernat/A. Meisel, Self-Determination, Privacy, and the Right to Die. A Comparative Law Analysis (Germany, United States of America, Japan), Europ. J. Health Law 4 (1997) 127 ff.; H.-M. Sass et al., Advance Health Care Documents in Multicultural Perspectives, Annual Review of Law and Ethics 4 (1996) 465 ff.; P. Rescigno, Self-Determination and Living Wills, in: C.M. Mazzoni (ed.), A Legal Framework for Bioethics, The Hague - London - Boston 1998, pp. 235 ff.
58. H.-G. Koch/E. Bernat/A. Meisel, Self-Determination, Privacy, and the Right to Die. A Comparative Law Analysis (Germany, United States of America, Japan), Europ. J. Health Law 4 (1997) 127 ff.; H.-M. Sass et al., Advance Health Care Documents in Multicultural Perspectives, Annual Review of Law and Ethics 4 (1996) 465 ff.; P. Rescigno, Self-Determination and Living Wills, in: C.M. Mazzoni (ed.), A Legal Framework for Bioethics, The Hague - London -Boston 1998, pp. 235 ff.
59. The Law Commission, Mental Incapacity (No. 231), London 1995, para. 5.14 (p. 71).
60. R.M. Veatch, Death, Dying, and the Biological Revolution, New Haven -London 1989, pp. 91 ff., 129 f.
61. Malette v. Shulman et al., 67 D.L.R. 4th 321 (Ontario Court of Appeal 1990). 39 67 D.L.R. 4th 323.
62. The cause of action was based on a supposed violation of the plaintiff's liberty interests. The claim only referred to compensation of non-pecuniary damages ("mental distress"): 67 D.L.R. 4th 325.
63. A similar (unreported) case has been discussed in Austria; cf. O. Maleczky, Unvernünftige Verweigerung der Einwilligung in die Heilbehandlung, ÖJZ 1994, 681 ff.
64. G. Tedeschi, On Tort Liability for "Wrongful Life", Israel L. Rev. 1 (1966) 513 ff.
65. BGH, JZ 1983, 447 (note E. Deutsch); for English law, see - concurring -McKay et al. v. Essex Area Health Authority et al. [1982] 1 Q.B. 1166 (Court of Appeal). This opinion has been overwhelmingly welcomed by literature; cf., inter alia, A. Laufs, Arztrecht, 5th ed., Munich 1993, margin number 349 with further references; but cf. E. Deutsch, Medizinrecht, 3rd ed., Berlin 1997, margin number 278.
66. BGH, JZ 1983, 447 (note E. Deutsch); for English law, see - concurring - McKay et al. v. Essex Area Health Authority et al. [1982] 1 Q.B. 1166 (Court of Appeal). This opinion has been overwhelmingly welcomed by literature; cf., inter alia, A. Laufs, Arztrecht, 5th ed., Munich 1993, margin number 349 with further references; but cf. E. Deutsch, Medizinrecht, 3rd ed., Berlin 1997, margin number 278.
67. BGH, JZ 1983, 447 (note E. Deutsch); for English law, see - concurring - McKay et al. v. Essex Area Health Authority et al. [1982] 1 Q.B. 1166 (Court of Appeal). This opinion has been overwhelmingly welcomed by literature; cf., inter alia, A. Laufs, Arztrecht, 5th ed., Munich 1993, margin number 349 with further references; but cf. E. Deutsch, Medizinrecht, 3rd ed., Berlin 1997, margin number 278.
68. BGH, JZ 1983, 447, 450.
69. BGH, ibid.
70. For more details, see Watch Tower Bible and Tract Society of Pennsylvania, Schutz der Familie und medizinische Behandlung für Zeugen Jehovas (1995).
71. The physician is definitely liable if he infringes upon the "rules of nature"; paradigmatic BGH, JZ 1953, 307 (note R. Schmidt): A woman was the victim of syphilis because she had received contaminated blood. The disease was communicated to her child who was conceived after the mother had been infected. See W. Selb, Schädigung des Menschen vor Geburt: Ein Problem der Rechtsfähigkeit? AcP 166 (1966) 76, 110.
72. The physician is definitely liable if he infringes upon the "rules of nature"; paradigmatic BGH, JZ 1953, 307 (note R. Schmidt): A woman was the victim of syphilis because she had received contaminated blood. The disease was communicated to her child who was conceived after the mother had been infected. See W. Selb, Schädigung des Menschen vor Geburt: Ein Problem der Rechtsfähigkeit? AcP 166 (1966) 76, 110.
73. For American law, see J. Hasl, Patient Autonomy and the Right to Refuse Treatment: Available Remedies, Saint Louis University Law J. 33 (1989) 711 ff. and J.R. Cornwell, Wrongful Life and the Problem of Euthanasia, Gonzaga Law Rev. 23 (1987/88) 573 ff.
74. For American law, see J. Hasl, Patient Autonomy and the Right to Refuse Treatment: Available Remedies, Saint Louis University Law J. 33 (1989) 711 ff. and J.R. Cornwell, Wrongful Life and the Problem of Euthanasia, Gonzaga Law Rev. 23 (1987/88) 573 ff.
75. A. Firlik, Margo's Logo, J.A.M.A. 265 (1991) 201.
76. This hypothetical case has been discussed by H. Kuhse, Problems of Personhood and Personal Identity: Do Advance Directives Allow One Person to Kill Another? in: P. Strasser/E. Starz (eds.), Personsein aus bioethischer Sicht (ARSP-Supplement 73), Stuttgart 1997, pp. 81, 84.
77. J. A. Robertson, Second Thoughts on Living Wills, Hastings Center Report 21/6 (1991) 6, 7; concurring R. Dresser, Life, Death, and Imconpetent Patients: Conceptual Infirmities and Hidden Values in the Law, Arizona Law Rev. 28 (1986) 373 ff. and J.G. Meran, Advance Directives and Surrogate Decision Making, Annual Review of Law and Ethics 4 (1996) 381 ff.
78. J. A. Robertson, Second Thoughts on Living Wills, Hastings Center Report 21/6 (1991) 6, 7; concurring R. Dresser, Life, Death, and Imconpetent Patients: Conceptual Infirmities and Hidden Values in the Law, Arizona Law Rev. 28 (1986) 373 ff. and J.G. Meran, Advance Directives and Surrogate Decision Making, Annual Review of Law and Ethics 4 (1996) 381 ff.
79. J. A. Robertson, Second Thoughts on Living Wills, Hastings Center Report 21/6 (1991) 6, 7; concurring R. Dresser, Life, Death, and Imconpetent Patients: Conceptual Infirmities and Hidden Values in the Law, Arizona Law Rev. 28 (1986) 373 ff. and J.G. Meran, Advance Directives and Surrogate Decision Making, Annual Review of Law and Ethics 4 (1996) 381 ff.
80. R. Dworkin, Life's Dominion. An Argument About Abortion, Euthanasia, and Individual Freedom, New York 1993, pp. 200 ff.
81. R. Dworkin, ibid., p. 211.
82. R. Dworkin, ibid., p. 212.
83. § 1 BGB (German Civil Code); but cf. § 22 ABGB (Austrian General Civil Code) which treats the unborn child as a juridical person from the moment of conception onwards. For more details, see K. Saerbeck, Beginn und Ende des Lebens als Rechtsbegriffe, Berlin - New York 1974.
84. See R. Dresser, Dworkin on Dementia. Elegant Theory, Questionable Policy, Hastings Center Report 25/6 (1995) 32, 35.
85. On so-called "Do-not-resuscitate orders" see A. Meisel, The Right to Die I, 2nd ed., New York 1995, § 9.4. (pp. 543 ff.), 1998 Cumulative Supplement, pp. 139 ff.
86. On so-called "Do-not-resuscitate orders" see A. Meisel, The Right to Die I, 2nd ed., New York 1995, § 9.4. (pp. 543 ff.), 1998 Cumulative Supplement, pp. 139 ff.
87. But cf. LG (regional court) Karlsruhe, NJW 1992, 756.
88. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
89. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
90. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
91. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
92. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
93. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
94. BGH, NJW 1995, 204 = BGHSt. 40, 257 = MedR 1995, 72; see A. Grubb, Med. L. Rev. 3 (1995) 312 ff.; R. Helgerth, JR 1995, 338 ff.; K. Dörner, Hält der BGH die "Freigabe der Vernichtung lebensunwerten Lebens" wieder für diskutabel? ZRP 1996, 93 ff.; T. Verrel, Selbstbestimmungsrecht contra Lebensschutz, JZ 1996, 224 ff.
95. The BGH, MedR 1995, 72, 74, makes references to three criminal law judgments that have already recognized the validity of the patient's presumed consent in a medical context: BGHSt. 32, 367; 35, 246; 37, 376.
96. The BGH, MedR 1995, 72, 74, makes references to three criminal law judgments that have already recognized the validity of the patient's presumed consent in a medical context: BGHSt. 32, 367; 35, 246; 37, 376.
97. The BGH, MedR 1995, 72, 74, makes references to three criminal law judgments that have already recognized the validity of the patient's presumed consent in a medical context: BGHSt. 32, 367; 35, 246; 37, 376.
98. The BGH, MedR 1995, 72, 74, makes references to three criminal law judgments that have already recognized the validity of the patient's presumed consent in a medical context: BGHSt. 32, 367; 35, 246; 37, 376.
99. Sc.: The time when the accused attempted to forego life-sustaining treatment.
100. See R. Merkel, Tödlicher Behandlungsabbruch und mutmaßliche Einwilligung bei Patienten im apallischen Syndrom, ZStW 107 (1995) 545, 563 ff., who doubts whether the legal concept of "presumed consent" "can be applied conclusively for the benefit of an incompetent patient who will with certainty never regain the capacity for self-determination."
101. See P. Alldridge/D. Morgan, Ending Life, N.L.J. 1992, 1536; but see J.M. Finnis, Bland: Crossing the Rubicon? The Law Quarterly Rev. 109 (1993) 329, 334: "One's living body is intrinsic, not merely instrumental, to one's personal life."
102. See P. Alldridge/D. Morgan, Ending Life, N.L.J. 1992, 1536; but see J.M. Finnis, Bland: Crossing the Rubicon? The Law Quarterly Rev. 109 (1993) 329, 334: "One's living body is intrinsic, not merely instrumental, to one's personal life."
103. See Airedale NHS Trust v. Bland [1993] 1 All E.R. 821, 860 f.: "In the case of a permanently insensate being, who if continuing to live would never experience the slightest actual discomfort, it is difficult, if not impossible, to make any relevant comparison between continued existence and the absence of it. It is, however, perhaps permissible to say that to an individual with no cognitive capacity whatever, and no prospect of ever recovering any such capacity in this world, it must be a matter of complete indifference whether he lives or dies." (Lord Keith of Kinkel).
104. P. Alldridge/D. Morgan, N.L.J. 1992, 1536, 1537.
105. H. Otto, Recht auf den eigenen Tod? Strafrecht im Spannungsfeld zwischen Lebenserhaltung spflicht und Selbstbestimmung. Gutachten D für den 56. DJT, Munich 1986, pp. 36, 73.
106. E. Starz, Rechtsethische Probleme in der Neonatologie, in: E. Bernat (ed.), Ethik und Recht an der Grenze zwischen Leben und Tod, Graz 1993, pp. 97 ff.; A. E. Buchanan/D.W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making, Cambridge 1989, pp. 246 ff.; K. Ulsenheimer, Therapieabbruch beim schwerstgeschädigten Neugeborenen, MedR 1994, 425 ff.
107. E. Starz, Rechtsethische Probleme in der Neonatologie, in: E. Bernat (ed.), Ethik und Recht an der Grenze zwischen Leben und Tod, Graz 1993, pp. 97 ff.; A. E. Buchanan/D.W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making, Cambridge 1989, pp. 246 ff.; K. Ulsenheimer, Therapieabbruch beim schwerstgeschädigten Neugeborenen, MedR 1994, 425 ff.
108. E. Starz, Rechtsethische Probleme in der Neonatologie, in: E. Bernat (ed.), Ethik und Recht an der Grenze zwischen Leben und Tod, Graz 1993, pp. 97 ff.; A. E. Buchanan/D.W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making, Cambridge 1989, pp. 246 ff.; K. Ulsenheimer, Therapieabbruch beim schwerstgeschädigten Neugeborenen, MedR 1994, 425 ff.
109. BGH, MedR 1995, 72, 74.
110. LG (regional court) Kempten 7 June 1995 - 2 Ks 13 Js 13155/93 (slip opinion), p. 16.
111. Richtlinien der Bundesärztekammer für die ärztliche Sterbebegleitung, Dt. Ärztebl. 90 (1993) C-1628.
112. Entwurf der Richtlinie der Bundesärztekammer zur ärztlichen Sterbebegleitung und den Grenzen zumutbarer Behandlung (dated: 25 April 1997), NJW 24/1997, XXIV.
113. See the living will form reprinted in G. Kalchschmid, Informationen der Patientenvertretung 1/97, 8.
114. Malette v. Shulman et al, 67 D.L.R. 4th 321 (Ontario Court of Appeal 1990).
115. LG (regional court) Kempten 7 June 1995 - 2 Ks 13 Js 13155/93 (slip opinion).
116. R. Merkel, Ärztliche Entscheidungen über Leben und Tod in der Neonatalmedizin, JZ 1996, 1145, 1155.